Repositório RCAAP

Cardiac hypertrophy is a component of cardiac remodeling and involves changes in the geometric structure, composition biochemistry, electrical generation and conduction, the volume of muscle cells, the organization of collagen and blood vessels. Excess thyroid hormone causes cardiac hypertrophy and hemodynamic side effects, but its association with physical exercise remains unclear. This study aimed to examine the cardiovascular responses to experimentally induced hyperthyroidism in physical training and their combination in rats. Thirty eight Wistar rats were randomized to four experimental groups: exercise (E), thyroid hormone and exercise (HTE), thyroid hormone (TH) and control (C). We evaluated the response of heart rate (HR) and blood pressure (BP) before and after intervention in each group and between them. The wet weight of heart and the LV was obtained at the end of the experiment and compared between groups. Also in this phase was evaluated by measuring the transverse diameter of cardiomyocytes and the results also compared between groups. The results showed that HR in group E was lower at rest compared to all groups. The HR decreased in group E and increased in the other groups at the end of the study. There was no change in BP. The diameter of cardiomyocytes increased in groups E, HT and HTE when it was compared to C. We conclude that the thyroid hormone alone or in combination with physical exercise promotes increased heart rate. Physical training was not able to reduce HR in the presence of HT. There was no difference between groups E, HTE and HT.

Nonalcoholic fatty liver disease (NAFLD) is common and widespread diagnosed by ultrasound (US). Steatosis grading by conventional US is subjective and presents great interobserver and intraobserver variability. Liver biopsy has been considered the gold standard for the diagnosis of NAFLD, but there are controversies about its indication. A non-invasive, objective and reproducible quantification of steatosis is necessary for clinical practice. The aim of this study was to assess the correlation between sonographic hepatorenal ratio (HRR), portal vein pulsatility index (VPI) and right hepatic vein pattern with liver biopsy for gradation of nonalcoholic steatosis. Ultrasound and Doppler US were performed in 82 subjects, among which 42, with NAFLD, also underwent liver biopsy. Forty normal volunteers were included as control group. The echogenicity of the hepatic parenchyma and right kidney cortex were measured using the histogram echo intensity and the hepatorenal ratio (HRR) was derived. The VPI was calculated as maximum velocity at minimum velocity divided by maximum velocity. The waveform of right hepatic vein was classified in monophasic, biphasic or triphasic. The specimens obtained through needle biopsy was stained by hematoxylin-eosin and Masson s Trichrome and classified as mild (up to 33% of the hepatocytes infiltrated by fat droplets), moderate (from 33 to 66%) and severe (over 66% of fatty infiltration in hepatocytes). The inflammatory infiltrate was discriminate as mild, moderate and severe intensity. The fibrosis was described according to location in the hepatic acinus, aspect and intensity. A significant correlation was found between histologic steatosis and HRR (r=0.80, P <0.01). The cutoff point of HRR presented sensitivity of 92.7%, specificity of 92.5% and accuracy of 92.6%. The mean and standard deviation in subgroups were: control 1.09±0.13; mild 1.46±0.24; moderate 1.52 ±0.27 and severe 2.04±0.31. The means of HRR were different among themselves, except between the mild and moderate subgroups. The VPI presented inverse and significant correlation with steatosis degree at biopsy (r= -0.74 P <0.01). The mean and standard deviation of VPI in control group was 0.34±0.08 and in steatosis group was 0.20±0.07 (P <0.01), dropping progressively according to the increase in steatosis degree. However, the VPI did not discriminate the steatosis subgroups. The Doppler waveform pattern of the right hepatic vein was predominantly triphasic in control and mild subgroup while the monophasic pattern was more frequent in severe steatosis (P< 0.01). However, the distribution of Doppler waveform pattern of the right hepatic vein did not show significant differences among mild, moderate and severe steatosis groups. In this study, Hepatorenal sonographic ratio was the best sonographic parameter for gradation of steatosis in patients with NAFLD.

Introduction: Protein Energy Malnutrition is one disease that contributes significantly to increased morbidity, causing impairment in response to treatments, inefficiency and delay in wound healing, decreased resistance of sutures, development of ulcers decubitus, glomerular filtration rate reduction, susceptibility to the development of infections and edema. The presence of these changes in malnourished patients is closely associated with increased cost and length of hospital stay and increased mortality. Hospitalized patients have high predisposition to development and / or exacerbation of protein-energy malnutrition due to metabolic stress inherent injury. Objectives: Identify associations between diagnosis of nutritional status by Subjective Global Assessment, frequency of complications, length of hospitalization, and clinical outcome of patients. Methods: To better evaluate the associations between nutritional status and outcome in patients at the Clinical Hospital of Federal University of Uberlândia, was developed a cross-sectional study with data collection from medical records of the file, about hospitalized patients between 01/07/2008 to 31/12/2008, and periodic follow-up of patients admitted during 01/09/2009 to 31/10/2009. Results: In the stage of retrospective data collection from medical records were included in the final analysis of 256 patients, 104 rated as "well nourished" (40.6%), 90 as "Moderate Malnutrition" (35.1%), and 62 as "Severe Malnutrition" (24.2%). Nutritional therapy was given to 15/152 (9.8%) malnourished and 11/104 "Well Nourished" (10.5%). Complications were identified in 50/152 malnourished (33.3%) and 17/104 "Well Nourished" (16.3%). Death occurred in 23/152 (15.3%) malnourished and 4/104 "Well Nourished" (3.8%). In only 18/152 charts the disease "Malnutrition" was included among the clinical diagnoses. In the stage of prospective data collection with tracking patients were evaluated at admission 73 patients as "well nourished" (66.9%), 28 patients as suffering from "malnutrition or Moderate Risk" (25.6%) and 8 patients as " Severe malnutrition (7.6%). During hospitalization, 11 patients developed or had worsening of malnutrition (10%). Nutritional therapy was administered to 22/36 "Malnourished" (61.1%). Complications occurred in 29/36 "Malnourished" (80.5%) and in 9/73 "Well Nourished" (12.3%). Deaths occurred in 12/36 "Malnourished" (33.3%) and 3/73 "Well Nourished" (4.1%). Discharge was given for 70/73 "Well Nourished" and 24/36 "Malnourished". The disease "Malnutrition" was included among the clinical diagnosis in only 5/36 records (13.9%). Conclusion: Malnutrition remains a actual problem, little recognized, valorized, and treated only sporadically, however have highly detrimental effect on the clinical course and prognosis of hospitalized patients.

Myelomeningocele (MM) is a disease that causes motor and sensitive disabilities. Health problems associated to this condition may lead mothers the main caregivers to situations of stress, anxiety and depression that may impair their health-related quality of life (HRQL). The aim of this study was to assess the HRQL of mothers of children and adolescents with MM in comparison to mothers of healthy controls and to observe its association with clinical and demographic variables of patients and mothers. The study group consisted of 50 mothers of children and adolescents with MM under 18 years of age in treatment at the Associação de Assistência à Criança Deficiente (AACD-MG). Mothers of healthy controls were matched by patients gender and age in the proportion of 2:1. Patients were grouped by level of neurological lesion and status of functional ambulation. Clinical and demographic data were obtained by interview and medical records. The HRQL of mothers was assessed by interview through the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). SF-36 reliability was evaluated by Cronbach s alpha coefficient. The Beck Depression Inventory (BDI) was self-applied to assess depressive symptoms. SF-36 scores were compared between groups of mothers of patients with MM and controls (Mann-Whitney test). Effect sizes (ES) were calculated to measure the m agnitude of significant differences. Clinical and demographic variables were compared (Mann-Whitney and Kruskal-Wallis tests) and correlated (Spearman correlation coefficient) with SF-36 scores. Mothers median age was 35.9 years (study group) and 33.5 years (control group). The median age of children with MM was 6.0 years. Most of the group consisted of children (90.0%), females (58.0%) and patients with lower lumbar neurological lesion (50.0%), non-ambulators (44.0%). Cronbach s alpha ranged from 0.6 to 0.8 for the SF-36 domains and components. In comparison to mothers of healthy controls, mothers of children/adolescents with MM had significantly lower scores in the physical component and in three SF-36 domains: role limitations due to physical problems, global health and role limitations due to social problems (p<0.05). Effect size was large (ES>0.8) in the following domains: role limitations due to physical problems and role limitations due to social problems. There was no difference in SF-36 scores according to patients level of neurological lesion and functional ambulation status (p>0.05). Among all patients and mothers clinical and demographic variables, patients gender (female), catheterization and presence of chronic disease in mothers were associated to impaired HRQL (p<0.05). The intensity of depressive symptoms was correlated to all domains and components of the SF-36 (p<0.05). In conclusion, mothers of children and adolescents with MM had a mental and mostly physical impairment in their HRQL in comparison to mothers of healthy controls. The impact was similar among the different levels of neurological lesion or functional ambulation status. Few associations were found among other clinical and demographic variables.

The prevalence of hospital malnutrition is reported to range between 20% and 50%. Due to increased metabolic demand, loss of body tissues and situations that impede or interfere the enteral feeding delivery, the prevalence of undernutrition among critically ill patients is even higher, ranging between 43%. The subjection of critically ill patients to hypocaloric diets or even fasting leads to metabolic changes and loss of body tissues, favoring undernutrition installation. Nutritional support enables the offer of energy and nutrients that are needed to impede undernutrition installation or even recover the nutritional status in already malnourished patients. The objectives of this study were to assess the nutritional therapy practices in the Adult Intensive Care Unit in the Clinical Hospital of the Federal University of Uberlândia, and afterwards, develop and implement an algorithm in an attempt to improve the nutritional therapy to the critically ill patients. This study was divided into two different phases. During the first phase the nutritional therapy routine was observed and registered. During the second phase, an algorithm was created and afterwards implemented in critically ill patients of the Adult Intensive Care Unit. Were enrolled in this study 32 critically ill patients, corresponding to 654 days, 542 enteral feeding days and 452 days of enteral feeding infusion. Four fasting periods were identified. After the algorithm implementation, the Initial Fasting Period decreased from 2.5 ± 2.4 in phase 1 to 1.0 ± 0.3 days in phase 2 (p=0.0465); the Tube Positioning Fasting Period remained the same, 2.0 ± 1.0 vs. 1.9 ± 0.9 days in phase 1 and 2, respectively (p=0.3126); the Diet Progress Fasting Period tended to decrease (7.2 ± 5.5 vs. 5.2 ± 1.3 days) (p=0.1398); and the Fasting Period Exclusively due to Interfering Factors was statistically the same, 13.1 ± 10.8 vs. 11.5 ± 5.7 days in phase 1 and 2, respectively (p=0.3486). During phase 1, patients remained in absolute fasting in 28.7% of the hospital days, and in phase 2 in 20.5% of the hospital days. If the effect of other study variables is controlled (sex, age, diagnosis, interfering factors, study phase, Acute Physiology and Chronic Health Evaluation II e hospital discharge), the proportion of infused volume / enteral feeding days (643 ml/day, p=0.006) and the proportion of infused kilocalories / enteral feeding days (612 kcal/day, p= 0.048) was higher in phase 2 than phase 1. During both phases it was also observed the incidence of interfering factors in tube feeding infusion. The main interfering factors were: tube feeding repositioning (phase 1 16.0%; phase 2 17.0%), vasoactive drugs prescription (phase 1 2.8%; phase 2 11.0%) and procedures (phase 1 7.0%; phase 2 6.2%). In this study, the algorithm implementation enabled early nutritional support, decreased patients exposure to fasting, improved the amount of energy and nutrients delivered to the patient and helped to control the enteral feeding interfering factors to critically ill patients.

Background: In patients with chronic renal disease (CRD) on hemodialysis (HD), left ventricular hypertrophy (LVH) is related to the increase in total peripheral vascular resistance (TPVR) and volume overload. The presence of residual diuresis (RD) enables greater control of these patients blood volume. Methodos: We evaluated the morpho-functional changes of the left ventricle (LV) in patients with CRD on HD with and without residual diuresis. Results: A total of 31 patients were divided into two groups using data from a Doppler echocardiogram: those with residual diuresis (G1) (n=17) and those without residual diuresis (G2) (n=14). In both groups, G1 vs. G2, differences in the cardiac index occurred (3.9 ± 0.20 vs. 3.0 ± 0.21 l/min/m2; p = 0.0056), systolic index (54 ± 2.9 vs. 45 ± 3.3 ml/b/m2; p = 0.04), end diastolic volume (141 ± 6.7 vs. 112 ± 7.6 ml; p = 0.008), end diastolic diameter (52 ± 0.79 vs. 48 ± 1.12 mm; p = 0.0072) and TPVR (1121 ± 56 vs. 1529 ± 111 dyne.seg.cm-5; p = 0.001 ). G1 had lower relative wall thickness than G2 (0.38 ± 0.01 vs. 0.45 ± 0.01; p = 0.0008). The ejection fraction (66.00 ± 1.24 vs. 66.0 ± 1.46%; p = 0.873) and the left ventricular mass index (132 ± 6.0 vs. 130 ± 8.3 g/m; p = 0.798) were similar in both groups. The urinary 24-hour volume correlated with relative wall thickness (r = -0.42; p = 0.0186) and with TPVR (r = -0.48; p = 0.0059). Conclusion: Distinct ventricular geometric patterns existed and were determined using the different RWT and TPVR in the groups with and without residual dieresis.

OBJECTIVE - To assess the frequency of malnutrition in ambulatory patients with hepatic cirrhosis (HC). METHODS - Seventy-eight patients were evaluated, 56.4% were male and 43.6% were female, mean age (standard deviation) 53.0 ± 7.7 years. The HC etiology was alcoholic in 56.4% of the cases, hepatitis C virus in 17.9%, hepatitis B virus in 15.4%, autoimmune in 2.6% and cryptogenic in 7.7%. According to the classification of Child-Pugh, 48.7% were A, 26.9% were B and 24.3% were C. Their nutritional state was determined by a subjective global assessment (SGA); body mass index (BMI); percentage of adequation of body weight (%BW), of triceps skinfold thickness (%TST), of mid-arm circumference (%MAC) and of the mid-arm muscle circumference (MAMC); serum albumin (ALB) and total lymphocyte count (TLC). RESULTS - Variable degrees of malnutrition were diagnosed in 61.5% (SGA), 16.7% (BMI), 17.9% (%BW), 93.5% (%TST), 62.8% (%BC), and 38.5% (MAMC) of the patients. The levels of ALB and TLC were compatible with malnutrition diagnoses in 43.5% and 69.3% of the patients, respectively. The frequency of diagnoses of malnutrition increased according to the severity of HC and it also increased in patients with alcoholic etiology. A greater depletion of adipose tissue in women and of muscular tissue in men was demonstrated. CONCLUSIONS - Malnutrition is frequent in ambulatory-treated patients. However, its diagnostic frequency varies according to the nutritional evaluation method used. The prevalence of malnutrition is greater in the more advanced stages of HC and in alcoholic etiology.

The objectives of the study were to evaluate the psychometric properties of Child Health Questionnaire (CHQ-PF50), Brazilian version, in children and adolescents with cerebral palsy (CP) and the health-related quality of life (HRQL) in this group against those of healthy people, considering the clinical types, severity of motor involvement and presence of epilepsy. The parents or guardians of children and adolescents 5 to 18 years old, with CP classified as spastic, extrapyramidal or ataxic, seen at AACD-MG, were asked to answer the CHQ-PF50 by self-administered technique, between December 2003 and April 2004. The scores were compared with those of healthy people and according to clinical types, severity of motor involvement and presence of epilepsy. The motor function was evaluated through the Gross Motor Function Measure. The motor severity was classified as mild, moderate and severe according to Gross Motor Function Classification System. The following psychometric properties were studied: missing data, floor effect, ceiling effect, item internal consistency, internal consistency reliability, item discriminant validity, discriminant validity, convergent validity, divergent validity, criterion validity, concurrent validity and construct validity. Ninety six parents or guardians answered the questionnaire. The patients age ranged from 5 to 17.9 years old (mean: 9.3). Psychometric properties were considered adequate. Patients scored significantly lower than healthy population in almost all scales, except on change on health, with large effect size in the summary of physical scores (4.4) and psychosocial scores (1.8). Summary of physical scores were significantly lower in quadriplegic patients, in severe form or in presence of epilepsy. There were no significant differences in the summary of psychosocial scores according to clinical types, severity level and presence of epilepsy. The results showed that CHQ-PF50 Brazilian version have adequate psychometric properties to be applied in patients with CP. By caregivers perception, CP had an important negative impact on HRQL in children and adolescents including physical, emotional and social well-being of patient and their families. The repercussion on physical construct is greater in quadriplegic patients, with severe form of CP or with epilepsy.

Introduction: pressure ulcers (PU) predispose to colonization by methicillin-resistant Staphylococcus aureus (MRSA) and represent an important reservoir of this organism in hospitals and health care institutions for elderly in the United States and Europe. Objectives: To evaluate the relationship between colonization and infection of UP by Staphylococcus aureus / MRSA, risk factors and outcome for bloodstream infection and nasal colonization by these microorganisms in patients with stage II or greater PU in hospitalized patients and residents of Long Term Care Facilities (LTCF) for elderly. Methods: The study was conducted at Clinical Hospital of Federal University of Uberlandia (CH-FUU) and three LTCF of city. The study design was prospective cohort in the hospital and an observational, longitudinal, in the LTCF. We included 226 volunteers, under active surveillance, of whom 145 were hospitalized and had stage II or greater PU, and 81 residents from LTCF, with or without PU, for 20 months period, from May to December 2005 and August 2009 - July 2010. PU were classified according to severity (stage I to IV) and the presence or absence of local infection by evaluation of clinical signs and microscopic by positive evaluation of wound s smears, by the ratio of inflammatory cells (polymorphonuclear) to epithelial cells of 2:1 per field, after staining by Giemsa. By active search, we evaluated the records of volunteers until discharge, death or transfer unit with the data reported on individual records. Clinical specimens were collected with swabs of the stage II or greater PU and nasal mucosa of volunteers in biweekly intervals until a positive result for S. aureus. The primary culture was carried through salt mannitol agar. The MRSA bloodstream infection was defined as blood culture positive. A single isolate of MRSA was found by volunteer and gender/ species identification was performed by classical phenotypic tests. The antibiogram was performed by agar diffusion technique according to CLSI standards 2005/2009. Results: Univariate statistical analysis of risk factors was performed by chi-square and Fisher exact test. The variables that showed association in the univariate analysis were analyzed by multivariate logistic regression model. The study was approved by the research ethics of the UFU, MG (118/05, 370/09). In the hospitalized group were identified 63 (43.5%) patients colonized with MRSA in UP, however, none of the analyzed risk factors was independently associated with this colonization. Association was found between patients with positive blood cultures and colonized by MRSA (OR: 19.0, 95% CI, 2.4 to 151.1, P <0.001) as well as for mortality (OR: 21.9, 95 % CI, 1.23 to 391.5, P = 0.002). The independent risk factors for MRSA bacteremia were two comorbidities (OR: 6.26 95% CI, 1.01 to 39.1, P = 0.05) and infected PU (OR: 12.75, 95% CI, 1.22 to 132.9, P = 0.03). The frequency of nasal colonization by MRSA was high in the hospitalized group, not being found in residents of LTCF. Conclusions: The study demonstrated that pressure ulcer colonized by MRSA was an epidemiologic reservoir potential of this organism in the hospital, with high-risk for MRSA bacteremia for patients and unfavorable prognosis as to the evolution. Due to the large dependence of these patients and their prolonged stay in the main hospital units, we recommend more attention on the participation of PU in the epidemiology of infections by multidrug-resistant bacteria as MRSA.

INTRODUCTION: Hepatitis C is an important cause of chronic liver disease worldwide. The grading of hepatic fibrosis in chronic hepatitis C (CHC) is important for better clinical management. However, until now, liver biopsy is the only test accepted for this purpose, despite their contraindications and complications. New methods for noninvasive assessment of hepatic fibrosis are under investigation. One proposal is the Doppler ultrasound, as a noninvasive, widely available and inexpensive. OBJECTIVES: To compare laboratory parameters and liver Doppler ultrasound of patients with CHC with a healthy control group and to correlate the portal vein index (PVI), splenic index, liver histogram and hepatorenal ratio (HRR) with degrees of hepatic fibrosis. MATERIAL AND METHODS: 50 patients with CHC with liver biopsy and 44 healthy controls underwent laboratory tests and Doppler ultrasound. We evaluated several ultrasound parameters, especially maximum and minimum speed of the portal vein, PVI, pulsatility index and resistance of the hepatic artery, splenic index, liver histogram, HRR and patterns of flow velocity of the hepatic vein. Compared the means between groups and were correlated with the degree of fibrosis with sonographic parameters. We used SPSS 17 for statistical analysis. RESULTS: The groups were matched for sex and age. Of the patients who underwent biopsy, 5 (10%) had F0 fibrosis, 12 (24%) F1 fibrosis, 22 (44%) F2 fibrosis, 9 (18%) F3 fibrosis and 2 (4%) F4 fibrosis. All patients had some degree of inflammation on biopsy and only four patients had moderate or severe steatosis. There was significant difference between groups when comparing the liver enzymes AST, ALT and GGT (p<0.001), and platelets (p=0.001). There was significant difference in sonographic parameters of PVI (p<0.001), splenic index (p=0.003), liver histogram (p<0.001) and HRR (p<0.001). The triphasic pattern of supra-hepatic vein was predominant in both groups. The ultrasonographic parameters were correlated with the degree of fibrosis and plotted the ROC curve. The PVI revealed an inverse correlation of r=-0.448 (p<0.001), AUROC of 78.4% (95% CI: 68.8 to 88%) and cutoff of 0.28 (Sensibility=73.5% and Specificity=71.1%), spleen index showed a correlation of r=0.354 (p=0.001). The correlation of liver histogram was r=0.416 (p<0.001), AUROC 74.4% (95% CI: 58.5 to 90.3%), a cutoff of 77.5 (Sensibility=60% and Specificity=74.4%); The HRR was correlated with fibrosis with r=0.509 (p<0.001), AUROC of 62.4% (95% CI: 46.4 to 78.5%) and a cutoff of 1.22 (Sensibility=60% and Specificity=65.9%). None of the parameters was significant for differentiating the degree of hepatic fibrosis. CONCLUSIONS: The platelet count and liver enzymes AST, ALT and GGT were significantly different between groups of patients with CHC and control, as well as the sonographic parameters PVI, splenic index, liver histogram and HRR. There were significant and moderate correlation between fibrosis and ultrasonographic data presented previously. However these parameters were not significant in differentiating the degree of fibrosis in the group of patients with CHC.

Introduction: Pressure ulcers (PU) are common in hospitalized patients and residents of Long Term Care Facilities (LTCF) for elderly, are susceptible to colonization/infection by bacteria epidemiologically important and potential source of secondary bacteremia. Objectives: To evaluate the colonization of the PU as a reservoir and/or source of infection by gram-negative bacilli (GNB), and the risk of evolution to secondary infection of the bloodstream and colonization of the oropharyngeal mucosa by these bacteria in patients hospitalized in Hospital de Clinicas, Universidade Federal de Uberlandia and in residents of LTCF. Methods: The study was conducted at Clinical Hospital of Federal University of Uberlandia and three LTCF of city. The study desing was prospective cohort in different clinics of hospital and longitudinal, in the LTCF, both during the period August 2009 to July 2010. The PU were classified according to severity (stage I to IV) and the presence of local infection by evaluation of clinical signs and microscopic by positive evaluation of wound s smears, by ratio of inflammatory cells (polymorphonuclear leukocytes) to epithelial cells of 2:1 per field, after staining the smear from the ulcer Giemsa method. The surveillance was conducted via active monitoring with the volunteers until discharge or death. Individual records for demographic data, clinical and development was completed. The collections of PU stage II and mucosal oropharyngeal swabs were performed and we used the means of MacConkey Agar (for PU and oropharyngeal mucosa) and Mannitol Salt Agar (for PU) in primary culture identification of gender/species was performed by classical phenotypic tests and antimicrobial resistance profiles were determined by means of agar diffusion according to CLSI standards 2005/2009. Results: In total, the study included 60 in patients and 81 residents of LTCF. Volunteers from both groups were elderly, with prolonged hospitalization average of 103 days for patients 91 months and they are in the LTCF. The frequencies of participants with PU colonized by BGN were similar and high, 83.3% and 77.7% in the hospital and the LTCF, respectively, with a predominance of polymicrobial colonization in both institutions. Among the predominant microorganisms recovered from PU: Escherichia coli, Klebsiella pneumoniae, among microorganisms of the Enterobacteriaceae and Pseudomonas aeruginosa between BGN non-fermenting. The presence of multidrug resistance was observed at rates greater than 50.0% between samples isolated from the hospital as opposed to those derived from LTCF. The independent risk factor for patients with polymicrobial colonization with PU versus monomicrobial for GNB was the presence of clinical infection at another anatomic site (P = 0.03). Overall, among patients colonized with PU BGN, about one-third were infected and 62.5% of this group progressed to bacteremia by the same organism/resistance phenotype of those isolated from ulcers, with a significant mortality (100.0%) Unlike evidenced by the residents of LTCF. The frequencies of colonization of the oropharyngeal mucosa in both groups of volunteers were also similar, but lower than observed in the PU and detection of multiresistant GNB only in hospitalized patients. Conclusions: PU colonized/infected with multidrug-resistant GNB are an important reservoir of these bacteria in the hospital with minor risk of bacteremia and poor outcomes.

Blomia tropicalis (Bt) and Dermatophagoides pteronyssinus (Dp) are the most prevalent house dust mites in tropical countries and associated with allergic diseases. Glycosilated antigens are highly immunogenic and involved in different pathologies, including allergies. The aims of this study were to evaluate IgE, IgG1, and IgG4 responses to Concanavalin A-binding components (Bt-ConA) isolated from Bt extract in sera of allergic and non-allergic subjects and to analyze the crossreactivity with Dp extract. Also, IgE-, IgG1- and IgG4-reactive antigenic components from both extracts were analyzed by Immunoblotting. Bt-ConA was obtained from Btwhole extract fractionated on Con-A-Sepharose affinity chromatography and both extracts were evaluated in SDS-PAGE and ELISA for IgE, IgG1, and IgG4 in sera of 121 patients with allergic rhinitis and 36 non-allergic subjects. Subjects were skin prick tested (SPT) to Bt-whole extract. Inhibition and immunoblotting test were performed to analyze IgE, IgG1, and IgG4 responses to both extracts. SPT showed that 58% of patients were sensitized to Bt (Bt+), with 52% reactive to both mites (Bt and Dp) and 6% to Bt only. A broad spectrum of proteins (14-152kDa) were visualized in Bt-whole extract and components >27kDa in Bt-ConA extract. ELISA showed a similar profile of IgE, IgG1 and IgG4 levels to Bt-whole and Bt-ConA extracts in different groups, although Bt+ patients showed a lower IgG4 reactivity to Bt-ConA extract. Specific IgG1 levels were higher in Bt+ patients than control subjects, and IgG4 levels showed no significant difference among the groups. ELISA inhibition showed a partial IgE and total IgG1 and IgG4 cross-reactivity with Dp extract for Bt-whole and Bt-ConA extracts. Immunoblotting revealed ten antigenic components in Bt-whole extract (14-152kDa) recognized by IgE and IgG4 antibodies and five of these components (>50kDa) were recognized by IgG1 in Bt+ patients. Bt- ConA extract showed eight antigenic components (27-152kDa), from which the 152 and 123kDa bands were predominantly recognized by IgE, and only three of these components (93, 123 and 152kDa) were recognized by IgG1 while IgG4 antibodies weakly recognized the 66 and 152kDa components in Bt+ patients. It can be concluded that Con A-binding components isolated from Bt constitute major allergens and are involved in both allergen sensitization (IgE response) and homeostase maintenance (IgG1 and IgG4 responses) and that glycosilated components, particularly those of high molecular weight, are preferentially recognized by IgE and IgG1, but not by IgG4 antibodies.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

OBJECTIVES: To evaluate the oral health status in type 1 diabetic patients and to verify the possible influence of diabetes duration and presence of chronic complications. MATERIALS AND METHODS: In this cross-sectional study 106 diabetic patients aged 14 to 29 years were submitted to clinical dentistry. RESULTS: 56.60% (60) of patients had periodontal disease. A significant association between the presence of calculus (p = 0.011) and periodontal disease (p = 0.045) with time of diagnosis of diabetes over five years. The presence of plaque (p < 0.0001) and chronic complications of diabetes (p = 0.024) showed significant association with disease. Of 84 medical charts analyzed, 75 (89.28%) had glycosylated hemoglobin > 7%, not possible to evaluate this parameter. CONCLUSIONS: Increased time of diagnosis of diabetes, presence of plaque and chronic complications of diabetes were significantly associated with periodontal changes.

Human milk is the ideal food for the child for several reasons, among them are the nutritional adequacy, protection against infections, better motor and intellectual development and reduction of chronic diseases. However, despite the importance of breastfeeding (BF), when it comes to newborn preterm infants, they face great difficulties in its establishment and continuity. This study aimed to evaluate the breastfeeding technique of preterm infants at discharge, one week, and one month after discharge; to know the rate of breastfeeding of preterm infants at 6 months of chronological age; and the main difficulties faced by mothers during breastfeeding. Participated in this study newborns (NB) with gestational age below 37 weeks and with birth weight less than 1500g, who were discharged between November 15 2008 and November 14 2009, and who were breastfed in the week preceding discharge. The breastfeeding technique was evaluated at discharge, 1 week, and 1 month after discharge, employing the protocol proposed by UNICEF. At these times it was also recorded the weight, the feeding type, and among the children who were not being breastfed it was asked the cause of weaning. At 6 months of chronological age, a telephone contact was made to check the ongoing of BF. Participated in the study a total of 45 pairs of mother/preterm infants. As for the ratings of the breastfeeding technique, due to the peculiarities of preterm newborns, this study found as difficulty factors the drowsiness of the newborn and the empty breasts of mothers, which contributed to the regular and low scores in the aspects Breast Response and Anatomy respectively. One week and one month after discharge and at 6 months of chronological age 81.4%, 48.7% and 23.2% were BF respectively. The average duration of breastfeeding was 80 days and the main difficulties faced by mothers were little milk, difficulty in grip and the refusal of the newborns to accept the mother s breast. Among the pairs who received a regular score at discharge in any of the aspects, only 11.1% remained BF up to 6 months of chronological age, and among those who received a low score in any aspect, none remained breastfeeding, suggesting that the difficulties encountered in evaluating the breastfeeding technique can jeopardize BF and, therefore must be detected so that appropriate measures are taken.

The breastfeeding is considered one of the main strategies for child survival and the Human Milk (HM) is the ideal food for the term newborn and pre-term newborn, with the capabilities to supply essential nutrients for their development. In the absence or insufficient volumes of milk from their mother, especially for hospitalized children as newborns pre-term, the option for human milk (HM) of donor human milk banks (HMB) becomes an effective alternative. The HMB as entities that support breastfeeding capture, process and distribute the LHO of donors, and this order is necessary to optimize operational and control of biological risks to secure their supply. The purpose of this job was to evaluate the hygienic-sanitary procedures used by the human milk donators during the milking and the domiciliary storage, as well as the transport from the HM to HMB and to associate the obtained data with the results of the quality control. By the observation of the milking and the domiciliary milk storage process, it was filled out a check list containing the hygienic-sanitary procedures and a social demographic research. Also, it was measured the temperatures inside the thermal boxes used to storage the milk during the transport of the DHM and noted in a spreadsheet. The results of the evaluation of the titratable acidity and the microbiological examination of the samples obtained during the observation was obtained in the register of the Human Milk Bank s of Hospital Clinics, Federal University of Uberlândia (HMB HC/UFU). It was used the chi-square test, logistic regression and the Sperman test to do the statistic analyses, considering p<0,05. It took part of this study 48 donators, with age around de 28,0±5,2 years old, 35% had conclude the high school and 46% had degree. About the procedures evaluated, 83% of the donators wash the hands before the milking, 87% had well cut nails, 94% fastened the hairs, 65% used mask, 73% cleaned up the breasts with filtered water and 33% wasted the first portion of milk, 90% chlorinated or sterilized the utensils; 85% of the samples of DHM were immediate stored under refrigeration after the collect. The average temperature inside the thermal boxes was less than (-)1°C. Two samples (4%) had acidity above 8º Dorni c and one sample (2%) had positive microbiological culture. It did not have association of the obtained data with the Dormic acidity and microbiological analyses. The hygienic-sanitary procedures, the storage and the transport of the LHO are in accordance of the regulations, suggesting an adequate orientation to the donators being done by HMB HC/UFU team.

Introduction: Systemic arterial hypertension (SAH) is an important risk factor for cardiovascular disease, the main cause of death in CKD patients. Fluid overload is an important component of hypertension in these patients and peripheral edema is one of its clinical manifestations. The aim of this study was to evaluate the association of edema with blood pressure behavior in incident PD dialysis patients. Methods: We analyzed 1089 incident PD patients from December 2004 to October 2007 of a large Brazilian cohort. Patients were followed for 12 months with a monthly evaluation of blood pressure and were subdivided into 2 groups according to a clinically detectible edema status: presence (E+) or absence (E-). The behavior of systemic blood pressure during the whole study period was compared between groups using analyzes of variance for repeat measures. Results: Mean age was 58.2 ± 15.3 years with a female predominance (56.9%). Mean systolic (SAP) and diastolic blood pressure (DAP) were 156.7 ± 18.7 and 90.0 ± 12.7 respectively. There was a reduction of SAP from 156.7 ± 18.7 at 1st month to 144.5 ± 24.7 mmHg at the 5th month (p < 0.05) but not of DAP (90.0 ± 12.7 to 85.6 ± 16.3 mmHg, p = ns). Both SAP and DAP levels remained constant until the end of follow up. At baseline the group E+ presented higher SAP, mean arterial pressure (MAP), body mass index (BMI), prevalence of erythropoietin use and older age. The differences in SAP and MAP remained constant between groups until the end of follow up. Conclusion: Initiation of PD partially corrects the increased arterial blood pressure of incident PD patients. Such incomplete response is associated with the presence of edema pointing to a pivotal role of fluid overload. The presence of clinically detectible edema can be a simple and important tool to guide the optimization of systemic arterial hypertension.

Introduction: The consumption of alcohol is a worldwide important public health issue, and during pregnancy, such use is even more important, since it can compromise maternal and fetal health. Objective: To verify the pattern of alcohol consumption, before and after diagnosing pregnancy, among postpartum women admitted at University Hospital, Federal University of Uberlandia. Method: We consecutively evaluated 493 puerperal women, in the period comprising June to September, 2009. To diagnose use/abuse of alcohol before pregnancy, AUDIT and CAGE questionnaires were used, and during pregnancy, T-ACE was used in addition. Another questionnaire was applied in order to collect socio-demographic data. For the statistical analysis we used either the Fisher exact test or the chisquare test. P <0.05 values were considered as significant. Results: For the period before the diagnosis of pregnancy, the CAGE was positive for 12.3% of the women and the AUDIT identified abstinence in 32.9% of them, low-risk usage in 47.3%, risky consumption in 14.8%, and alcohol abuse or probable dependence at 5.0% of the women. During pregnancy, CAGE and T-ACE were positive for 13.1% and 17% of pregnant women, respectively; the AUDIT identified abstinence in 76.9%, low-risk usage in 14.8%, risky consumption in 5.5 % and alcohol abuse or probable dependence at 2.8% of the patients. Among women who were alcohol users, two thirds have stopped drinking after the diagnosis of pregnancy, regardless of the number of prenatal appointments; and less than 50% of them were advised not to drink. Pregnant women who either used or abused of alcohol attended fewer prenatal appointments. During pregnancy, alcohol consumption was more common among mothers with fewer education and among those not living with a partner, and we observed no relationship between patterns of alcohol consumption bound to skin color, family income, number of previous miscarriages and having a religion or not. Conclusions: We found worrying alcohol consumption among the evaluated pregnant women, especially in the period before the diagnosis of pregnancy, which shows us they were using alcohol during a still undiagnosed pregnancy. Thus, counseling in regard of alcohol use should be made to all women of reproductive age. AUDIT was the instrument that most frequently diagnosed alcohol use during

Objective: The objective of this study was to compare the parameters of nutritional evaluation in the presence or absence of residual diuresis in chronic kidney patients submitted to hemodialysis (HD). Methods: This transversal study evaluated 43 chronic kidney patients undergoing HD; their average age was 53.5 ± 11.6 years and the average time of diuretic treatment 22.1± 13.9 months. To acess the nutritional status, were measured weight, eight, tríceps skinfold thickness (TSF), biceps, subescapular and suprailiac, beyong the midarm circunference (MAC). In order to evaluate their nutritional state, body mass index (BMI), body fat (BF) and the muscular circumference of the arm were evaluated. The Subjective Global Assessment (SGA) was used for diagnosis of the nutritional state. Albumin, creatinine and total cholesterol (CT) were collected. Through the normalized protein equivalent of total nitrogen appearance (nPNA) and of a 3 day food register, protein-energy intake was estimated. The adequacy of dialysis was evaluated by Kt/V and a 24 hour urine collection was performed. According to the measure of urine volume, the individuals were divided in: group D- (0 400 ml) and group D+ (>400ml). Results: In anthropometry, group D- presented average values inferior to those of group D+ in the calculations of BMI (22.4 ± 3.5 kg/m2 vs 24.9 ± 3.8 kg/m2, p=0.034) and of BF (24.2 ± 8.0 % vs 31.3 ± 8.4 %, p=0.007), in the measure of SKF (12.6 ± 5.4 mm vs 17.0 ± 6.9 mm, p=0.022) and in the adequacy of MAC (93.5 ± 11.8 % vs 102.6 ± 12.34 % , p=0.021). In accordance with TSF adequacy, group D- was classified as undernourished (<90%) and group D+ as eutrophic (90-110%). According to the SGA diagnosis, both group D- and D+ presented a prevalence of elevated nutritional risk (84% and 88.9% respectively) and D- had a prevalence of moderate/severe undernourishment three times greater than D+ (16% vs 5.5%). The average protein energy intake was similar in both groups. Only group D- presented a low value of CT (148.8 ± 55.2 mg/dl), which is considered nutritional risk. Albumin did not act as a marker of malnutrition with an average superior to the value recommended for this population both in D- (3.8 ± 0.35 g/dl) and in D+ (3.8 ± 0.55 g/dl. p=0.903). Conclusion: Patients with smaller urinary volume presented a reserve of body fat and lean body mass inferior to the patients with normal diuresis, thus manifesting the importance of the preservation of the volume of residual diuresis in dialytic treatment.

Dermatophagoides pteronyssinus (Dp) is an important specie of house dust mite associated with allergic diseases. Allergens from Dp are important causes of sensitization and mediated responses to specific immunoglobulin E (IgE) among patients with asthma and allergic rhinitis. The aim of this study was to produce recombinant protein Der p 1 and Der p 1-related IgE binding epitopes (rDer p 1172-243) to evaluate their reactivity to IgE in the serum of mite sensitized individuals using enzyme immunoassays. The sequences of rDer p 1 and rDer p 1172-243 were amplified and subcloned into E. coli. After expression and purification the reactivity of IgE to rDer p 1 and rDer p1172-243 was determined by ELISA. The results showed that rDer p 1 expressed in E. coli presented an estimated molecular weight of about 26 kDa and rDer p 1172-243 about 8kDa. The expressed rDer p 1 protein and rDer p 1172-243 reacted positively with IgE in 88% and 84% of sera from allergic patients, respectively. However, sera from negative patients showed crossreactivity to rDer p 1, although the same was not observed for rDer p 1172-243. It can be suggested that rDer p 1172-243 are promising candidates for the diagnosis of allergy caused by D. pteronyssinus in mite sensitized patients.